Claims Services Clause Samples

Claims Services a. Wellbeing Services Limited will not commence the Claims Services and process Your Claim(s) until Wellbeing Services Limited receives Your Instruction. b. Wellbeing Services Limited will use reasonable endeavours to request the Loan / Credit Card Provider confirms whether You held a Loan(s) / Credit Card(s) with them, by making a SAR. c. If no Loan(s) / Credit Card(s) is identified, this Agreement will come to an end. d. You authorise this Agreement to continue on any Loan(s) / Credit Card(s) that has been identified by Your Loan / Credit Card Provider. e. Wellbeing Services Limited will investigate and, if appropriate, based on the information provided by You and the Loan / Credit Card Provider, prepare, submit and handle Your Claim(s) to the Loan / Credit Card Provider and/or the FOS on Your behalf. If Wellbeing Services Limited does not believe there is merit for Your Claim(s) Wellbeing Services Limited will notify You and provide information about Your next steps. f. You understand that by completing and signing one LOA, the Loan / Credit Card Provider may investigate all Loan(s) / Credit Card(s) held with them under the Instruction provided, and that any successful Claim(s) will be subject to a Fee(s). g. Wellbeing Services Limited will use reasonable endeavours to obtain Compensation for the Claim(s) pursued. h. Wellbeing Services Limited will update You about any significant development in Your Claim(s) using Your preferred contact method, including by email, telephone and/or post. You will receive at least one update per Claim(s) every six months.

Claims Services. Assist Company by (i) processing, examining, investigating, paying, and administering claims and (ii) providing general claims advice. Final decisions will be based upon guidelines and procedures established and approved by the Company from time to time and communicated in writing to Servicer by the Company, and (ii) the Company retains final approval authority on all claim payments. Payment of claims shall be made using the Company’s checks. In performing claim services for the Company pursuant to this agreement, Servicer shall obtain and maintain all necessary licenses and permits required in order to comply with applicable laws and regulations, including an Independent Adjuster’s License.

Claims Services. 1. Establish reporting procedures which are compatible with the needs of the EMPLOYER. 2. Provide necessary forms and instructions for use. 3. Receive and examine on behalf of the EMPLOYER all reports of employee injury claims. 4. Conduct investigations that will disclose all of the pertinent facts on any accident as deemed necessary to allow determination as to compensability. 5. Accept or deny all reported claims for employee injuries on behalf of the EMPLOYER in accordance with the applicable Workers' Compensation Law. 6. Employ outside professionals such as private detectives, expert witnesses, field claim adjusters and attorneys to assist in the investigation, should it be necessary, at the expense of the EMPLOYER, subject to prior approval by and consultation with EMPLOYER. 7. Review all medical bills and other services for which a claim is being made for reasonableness and conformity to appropriate medical and surgical fee schedules through our specialized Cost Containment Unit. 8. Subject to approval by the EMPLOYER, the COMPANY will adjust and settle all reported claims. Payment of claims will follow city ordinance guidelines and the City Council will approve claims that exceed dollar thresholds as stated in the ordinance. Such settlement is to include preparation and execution of all necessary compromise and release agreements. 9. Prepare and maintain files necessary for legal defense of claims and/or litigation (such as actions for subrogation) or other proceedings. 10. Pay in a timely fashion and for appropriate amount all claims and expenses pertaining thereto from the Working Loss Fund. The Working Loss Fund will be established by the EMPLOYER and will be maintained at a dollar level sufficient to meet the monthly obligations. 11. Conduct an ongoing review of all open cases where appropriate to establish the status of each disabled employee claim in order to bring to an amicable conclusion. 12. Provide EMPLOYER with narrative status reports of major or litigated claims. 13. Provide coordination with rehabilitation of injured employees in the consultation, retraining and reassignment of employees with limited physical abilities arising from covered injuries, at the expense of the 14. In coordination with EMPLOYER, maintain a current roster of qualified physicians for the treatment of covered injuries on a first and specialized basis, as well as maintaining procedures for close liaison with the treating physicians. 15. The EMPLOYER will establi...

Claims Services a. TCG will not commence the Claims Services and process Your Claim(s) until TCG receives Your Instruction. b. You may also be asked to complete a Payday Lending Questionnaire to allow TCG to investigate the existence and merits of the Claim(s). c. You understand that by completing and signing one LOA, that the Loan Provider may investigate all Loan(s) held with them under the Instruction provided and that any successful Claim(s) will be subject to a Fee(s). d. Once Your Instruction(s) has been received TCG has the right to deal exclusively with the Claim(s) and you acknowledge that You could complain directly to the Loan Provider, at no cost. e. You will ensure that any information provided is true, accurate and completed to the best of Your knowledge. f. You will deal promptly with requests by TCG for authority, information or documents that TCG or the Loan Provider might make. g. The Loan Provider may contact You directly and You will inform TCG promptly of this and any relevant matters affecting Your Claim(s). h. TCG will use reasonable endeavours to obtain Compensation for the Claim(s) pursued.

Claims Services. WPS shall provide the following administrative services: Inquiry services; Determination of CHARGES; Medical advisor review; Pattern practice review; Coordination of BENEFITS; Appropriate claims edits; BENEFITS determination; Payment of BENEFITS; Preparation and sending Federal Form 1099 to providers (ETF specific are not required); Subrogation services.

Claims Services. ‌ WPS shall provide the following administrative services: 1. Inquiry services;

Claims Services. We will not commence the service or proceed with your claim(s) until we receive your signed instruction in the form of the LOA. • We will make all endeavours to obtain the relevant information from your provider, lender or advisor about your investment. • We will do this by sending them an Access Request under the Data Protection Act 2018. • If there is no investment this Agreement comes to an end. • You authorise us that this agreement will continue, on any claim on any investment or pension we identify as being a viable claim until this agreement is terminated. • By signing one LOA it will allow us to pursue all investments or pensions held with that provider which may result in multiple claims upon which successful claims would incur a fee. • We will investigate all information provided by you, your provider and the Ombudsman in order to pursue all viable claims for compensation. • We will contact you during the course, of the claim at each important stage, as described in the Key Information document. • We contact you by the methods given at the outset of our agreement. These may be by letter, phone, text or email, or a combination of all four.

Claims Services. Delta Dental shall provide the following claim services: a) Delta Dental will pay Benefits for dental services described in the attached EOC when provided by a Provider and when necessary and customary under generally accepted dental practice standards. Claims shall be processed in accordance with Delta Dental’s standard processing policies. The processing policies may be revised from time to time; therefore, Delta Dental shall use the processing policies that are in effect at the time the claim is processed. Delta Dental may use dentists (dental consultants) to review treatment plans, diagnostic materials and/or prescribed treatments to determine generally accepted dental practices and to determine if treatment has a favorable prognosis. Limitations and exclusions will be applied for the period the person enrolled under any Delta Dental program or prior dental care program provided by the Contractholder subject to receipt of such information from the Contractholder or at the time a claim is submitted. Additional waiting periods, if any, are shown in the attached EOC. If an Enrollee receives dental services from a Provider outside the state of New York, the Provider will be reimbursed according to Delta Dental’s network payment provisions for said state according to the terms of this Contract. If a primary dental procedure includes component procedures that are performed at the same time as the primary procedure, the component procedures are considered to be part of the primary procedure for purposes of determining the benefit payable under this Contract. If the Provider bills separately for the primary procedure and each of its component parts, the total benefit payable for all related charges will be limited to the maximum benefit payable for the primary procedure.

Claims Services. 1. Party A shall actively coordinate with all co-insurers to handle insurance claims in accordance with relevant laws and regulations. 2. Party A shall implement “fast payment” settlement of claims as required by the [*****] Provincial Medical Security Bureau. 3. For “[*****]” insured persons who receive inpatient treatment at designated medical institutions or incur medical expenses for certain high-cost drugs (at outpatient departments of designated medical institutions and dual-channel pharmacies under medical insurance), the claims will be rapidly settled after basic medical insurance settlements. 4. The medical expenses of the insured shall be reimbursed by Party A, which will allocate the funds to the insured based on the data provided by the medical insurance department. 5. Party A will initially advance the claim expenses and, on the day of each claim data push, will prepare the “[*****] Commercial Health Insurance Claims Expenditure Statement (Year Month Period).” Co-insurers must, within 10 working days of receiving the monthly claims expenditure statement from Party A, transfer the claim payments into the designated account of Party A according to their respective shares. Party A will provide only this document as the basis for reimbursement of claims, and co-insurers may not delay or refuse reimbursement on the grounds of incomplete documentation. Each co-insurer should designate a person responsible for settlement. The main responsibility for subrogation lies with Party A, with the cooperation of all co-insurers, and the proceeds from subrogation, after deducting the expenses, should be distributed according to the co-insurance ratio. Co-insurers that fail to pay the reimbursement within 10 working days must pay a late fee of 10% of the claim amount due to the lead insurer and are not eligible to participate in the next “[*****]” project ([*****] 2025). Party A’s Claim Transfer Account: Account Name: […] Bank Account Number: […] Bank: […] 6. The amount of claims paid by each co-insurer must be consistent with the amount confirmed by Party A, and no refusal to pay claims is allowed for any reason. In cases of system errors or operational mistakes, co-insurers should settle the claims with Party A first, and if Party A confirms that there was an error in payment, adjustments should be made during the settlement of the following month’s claims. 7. For special claims cases, Party A may organize a consultation with the co-insurers to jointly negoti...